February 05, 2011

Brachytherapy

I've received from feedback that some of what I've put up on this blog over the past few days has been useful to someone that was about to undergo brachytherapy at MGH. So, in the spirit of "this is what happened to me - it may not be that way for you," I've decided to put up my notes about what happened during the procedure before my mind actively forgets the whole experience. Maybe this will help someone else get a sense of what the whole thing is about. Overall, I thought that it would be pretty weird having radioactive seeds place in your body. It was.

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Pre-Procedure

"The Procedure" (as we love to call it) actually starts the day before you get to the hospital. You're given a long list of things not to do before the day of the operation, but the most important is that you can only eat "clear liquids" the day before. So, unless you're into bullion as some sort of life-style cleanse, this means that you're pretty much living on soda for the day. This is not my favorite diet and one that makes me sluggish and hypoglycemic. So, if you're like me, don't plan on actually getting much done the day before. You're not going to have a the fuel to do it.

Also, they tell you to get a bottle of magnesium citrate (a powerful laxative) and drink it at 3pm. I gather that the object here is to clean you out so that there are no obstructions to the ultrasound that they are going to put up your butt so that they can guide where the seeds go during the operation. For whatever reason, it means a start on developing a relationship with your plumbing which will come to full fruition Post-Procedure.You might want to check what you want in terms of reading materials in the bathroom at this point in the process. You're going to be there for a while.

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Procedure-Procedure

On the big day, Denise and I slide along the roads into the MGH from Roslindale for a 6am appointment at the start of a January snowstorm. This puts a bit of an edge on the festivities that would have been edgy anyway. Though I had a "sick kid" childhood, I've somehow managed to avoid being hospitalized all my life. This is my first big meet-up with Extreme American Medicine and, for this fact alone, I'm not looking forward to the day. I'd had no real food the day before and I've ingested nothing at all since midnight. This made me even more out of sorts for some reason. And then also, for some reason, I found it hard to sleep, especially since I had to get up at 4am to make it to the hospital by 6am. This should have made for a very cranky Spriggs, but I'm focussed as I get ready for the hospital.

On the other hand, I have to be happy that I'm the first surgery of the day. This is fine with me - I'm getting worked on before they get tired of doing what they do for a living (and it is Friday, after all).

So we arrive at the Wang Building of MGH, just prior to 6am during a snow storm - making it difficult to read the portents of the day. Me? I don't seem to care much since I'm already in some sort of strange, calm altered state that means that I"m either very Zen or hypoglycemic. Maybe both.

Denise and I check into the slightly crowded and quietly anxious pre-op waiting room. At only a few minutes after 6, Denise and I are collected by Suzanne, a pre-op nurse who's obviously been doing this stuff for a while who leads us into the outer sanctum of surgery. She's the first in a number of waves of nurses and doctors who will ask me questions in order to get a more complete medical history, tell me what's coming, and, most importantly, ask me what my birthday is (am I the real Marshall T. Spriggs that they're going to be working on?) This whole process takes about an hour and a half to two hours.

We are taken into one of those little curtained "rooms" off the operating room and I was told to take off my clothes which are then bagged and put on a hosptial Johnny. They were very happy that I left my jewelry and partial plate at home (they were very impressed that I did this for some reason) and that I had brought an eyeglass case. After this was accomplished,, I was in my regulation hospital togs, and I was directed to lay down, the interrogation started for real (in the nicest possible way).

After this Suzanne disappears, the pleasant and busy Susan (as opposed to Suzanne) introduces herself as my nurse/anesthesiologist. Susan also asks my birthday and several other more pertinent medical questions as she tells me what is going to happen. This leads eventually to her inserting an IV into my arm for a dose of Demerol that she says will "relax me." This it does, though I feeling pretty relaxed anyway for no rational reason. In a couple of minutes I start of feel a bit fuzzy. Thankfully, no one asks me my birthday.

I do get a chance to have a good discussion with her about my anxieties about breathing during the surgery. I am anxious about this part of the tour probably most of all as a result from having quite a few times in my earlier life where the breathing thing was an issue. So it feels good to be able to emphasize that I want to come out of this continuing to have this function. Though she's very busy, Susan does listen quite closely to what I have to say and that makes me feel better about this. Score one for the wonderful Susan.

I get one last shot at the medical professionals as the operating room nurses come by. They seem to be worried about getting me from one table to the other in the OR and ask if I have any problems with my back. I say, "yes, sometimes I have back spasms." I explain that I used to study a martial art that was like judo and I landed on my back quite a bit when I did it. One of the nurses asks what I do when this situation arrives. I reply that I stay on the couch for a couple of days until it stops hurting. They give me odd looks and then leave.

The final member of the team finally shows up almost as an afterthought. The anesthesiologist and I joke about the size of the needles that they're going to use on me. (Yes,long, but not as long as I thought). Seems like just another Friday for him, which is strangely comforting to me since it definitely isn't for me.

Denise is told that it is time to go. They get her cell phone number and tell her where it's probably best to get breakfast and wait. They will give her a call when they are finished and will come out to talk to her while I'm recovering.

Of course, time passes quickly when you're having fun (and on Demerol) and the pre-op process takes a quick two hours - scheduled for a time of 8am - and they, on time, roll me out of the curtained area in through some doors directly into the operating room. By this time I'm unfortunately very unfocussed and incapable of asking about all the fun shiny steel stuff that's all around. I do notice that members of the team is there but I don't really see the surgeons to talk to them. I just a wave at them as I move myself onto the OR table. Not that I couldn't see them to talk to, I suppose, but by this time I'm so "relaxed" that I couldn't have a coherent conversation with them anyway. They know this and don't even bother to talk to me

Susan is there with an oxygen mask to cover my face. Three deep practice breaths, one more, and then:

Black.

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Post-Procedure

Light.

Big pain the in dick. Or maybe the ass. Or maybe somewhere in between. Hard to get that specific when you're coming out of anesthesia and everything is a jumble. But I awake to pain - but not massive, overwhelming pain, but pain nonetheless. And this oddly provides some sort of focus for returning to the light.

The first thing that I can focus on is Moira, the post-op nurse. She has a calm demeanor and pleasant face, but also the look of the sadness of someone who's seen a little too much of life. I wish that I could make her smile. But in the meantime, I'm in pain. She looks at me, asks me if I'm okay, and I seem to be able to talk or mumble something. She asks if I'm in pain and I say that I am. She asks me if I want a Percocet. I nod yes. There's a reason that they call nurses Angels of Mercy.

The next hour is spent slowly coming back to consensual reality and getting help taking a couple of trips to the bathroom. These trips are the next major landmarks and adventures of the day. They want to be sure that there aren't any urinary blockages before they'll let me go home. But, of course, first I have to be able to stand and that takes a large measure of effort and concentration. The pain begins to subside and I drink a couple of ginger ales and eat a couple of crackers, Moira determines that I can go home and she gives me my bag of clothes, escorts me back to the bathroom and I start to complete what has become a complicated process of dressing myself. They told Denise that I'd be out for about 20 minutes after getting into recovery. Knowing me, she told them that I'd be out for an hour. She was right.

By the time that I'm finished dressing, Denise has arrived with a wheelchair and I find myself being wheeled out of the operating suite, down the elevator, and out into the MGH lobby where I get to see everybody cope with the snow storm while D goes for the car in the parking garage across the street. Very nice cops on duty at the entrance allow D to live park while she picks me up and make sure that I actually get into the car since footing isn't very good in the snow and I'm still not very steady.

The storm has backed off and the streets are just wet heading back home. We roll into the parking place in front of the Roslindale house at 1pm. Eight hours house to house. Just a quick trip to pick up a few dozen radioactive seeds.

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Home

I imagine that this is where this chronicle of my experience will be of least use to the general population. All us have different bodies that will react differently to having foreign objects placed in them. But, since people don't go through this process everyday maybe there is some useful stuff in here. But please be advised that all conclusions that I've come to, especially about this phase of the process, are up for re-evaluation as I go through them. The process is not only an on-going one, but has provided me with some surprises that I didn't expect.

First, there seem to be at least two phases to this recovery thing - immediate recovery and acclimatization. At the point of this writing (two weeks later), I seem to have gone through the first, with the second being what I'm in at the moment. After this? A third phase? Who knows?

Immediate Recovery

This first phase seemed to take about a week.

The first order of business is to shake off the anesthesia. This actually seemed to take me a couple of days. My pain was very minimal and well controlled by Tylonol. I was sore both inside and out however. The body seemed to be going through a lot of subtle internal changes and I made sure to follow what it told me it wanted: food (especially after being starved for a day and a half), sleep, and frequent trips to the bathroom. It seemed that I could go for a period of time lying down without heading to the john, but as soon as I sat up it was a signal that it was time to hit the plumbing. Fortunately, I live in a small apartment and the distance between the couch in the living room and the bathroom is about 30 feet.There was some blood in the urine, but very little and my appetite was surprisingly good.

All in all it was pretty much of a seat of your pants week with me trying to find my way back while eating, sleeping, and especially peeing according to no prearranged nor regular schedule. Energy levels were up and down and though I could do some intellectual work, I couldn't do it for long. Since I'm a primarily a writer when I'm home, this lack of concentration wasn't much of a problem. Actually, it was alot like life, execept that it happened at 4am.

I was given a set of three drugs to take once I got home. First was Cipro that guarded against infection at the points where they put the needles into the body. Second was a steroid that tried to keep the prostate from swelling and shutting down the urethra that goes through it. And then there was Flomax which is used to relax the prostate in general making it easier to urinate. A note here: a talk with your pharmacist is a good thing to do when you pick up your drugs. Mine noted that Flomax can result in a lower blood pressure and therefore it is best to take it just before bed. Neither of my uro-guys mentioned this when I talked to them about the drugs.

The most amusing part of the first three days was the necessity for me to pee through a paper strainer. It seems that seeds can actually be ejected through the urethra during the first few days if they are not placed perfectly and the docs want to cut down on the Iodine-125 in the water supply. So, I was instructed to pee through the strainer and, if anything came out, to pick it up with tweezers and put it into a lead-lined salt shaker that I had been issued. In my case, no seeds emerged, but I may keep the salt shaker as a souvenir – my own personal Yucca Mountain.

I do remember sitting on the couch on the Wednesday after the Friday and suddenly feeling like I was "back". I was grateful for this. I was weak but functional and had my center back under me for the first time. I went outside for a few minutes the next day for the first time and that felt significant. For the first time, I could actually get away from a bathroom for a half an hour. Of course, I was careful to go somewhere with easy access to a Men's room.

It was also at this point that my radiation oncologist called me up to check on me and tell me that I should remember that the "symptoms" would be coming back with a vengeance very soon. He also reminded me that I had purple balls due to bruising. Love that guy, even if he was right.

Phase Two -

Saturday of last week I woke up warm. I was especially warm way down deep inside. It had taken a week for the seeds to start to cook the prostate (and hopefully the cancer cells in it). As far as "symptoms," it was back to not quite Square One again. Let's say Square One and a Half.

The body feels okay, but somewhat alien as it tries to digest the fact that it has radioactive foreign bodies in it and it's a little wonky as a result. Or maybe it's my reaction to the steroids that I've taken to keep down the swelling. For this week, I get burst of energy followed by periods where I feel like I weigh 90 pounds. My concentration goes from being able to concentrate to write pieces like this to being confused about how to empty the dish washer. Not being a terribly linear thinker in the first place, this is not terribly upsetting to me, but it is pretty weird that my most productive part of the day has somehow been transferred to the 3-5am timeslot. I was constantly feeling dehydrated and pouring liquid in translated directly into liquid immediately coming out.

I've gone off the steroids for the past couple of days and many of the above symptoms have eased off. Head is clearer and I'm able to get more sleep. Of course, I'm still going back and forth to the bathroom approximately once a half and hour but I'm not feeling so thirsty all the time.

Progress has been slow, but it does seem to be happening.

So, that's the way it stands here on Day 15 of "My Brand New Radioactive World" (probably a good name for a band at some point). More updates as data becomes available.